Back to Annual Meeting Program
Nonsyndromic Single-Suture Metopic Craniosynostosis in the Fourth Dimension: An Evaluation of Complications, Revisions, and Long-Term Outcomes in 142 Patients Over 30 Years
J T. Paliga, BA, Jesse Goldstein, MD, Ari Wes, BA, Linton A. Whitaker, MD, Scott Bartlett, MD, Jesse A. Taylor, MD.
University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: This study was designed to evaluate the long-term outcomes of patients with isolated metopic synostosis throughout the evolution of treatment at a single institution.
METHODS:An IRB approved retrospective chart review was performed on consecutive patients undergoing correction of metopic craniosynostosis from May 1978 to June 2012 at the Children’s Hospital of Philadelphia. Inclusion criteria required a diagnosis of metopic craniosynostosis, complete medical record and at least one year of follow-up. Patients were excluded if they had undergone previous interventions at other institutions or were diagnosed with syndromic or multisutural craniosynostosis. Demographic information, operative details, and post-operative course were collected. Outcomes were reported as Whitaker classification and post-operative clinical characteristics as assessed at the most recent clinical evaluation prior to any additional interventions, as well as the need for reoperation in patients with greater than 5 years of follow-up. Chi-squared and Fisher’s exact test were used to compare all categorical variables. Wilcoxon rank-sum and Kruskal-Wallis rank tests were used to compare all continuous variables.
RESULTS:From 1978 to 2012, 142 patients underwent surgical correction of isolated metopic craniosynostosis of which 113 met inclusion criteria. Average age of surgery was 0.83 (range: 0.3-4.7) years, and average follow-up was 6.0 (range: 1.0-17.8) years. There were ten surgical complications (8.8%). Three (2.6%) were considered major complications including one post-operative mortality in a patient with hypoplastic left heart syndrome and two reoperations for a post-operative hematoma and post-operative infection. Minor complications occurred in 7 (6.1%) patients and included hematoma (n=2), seroma (n=2), wound infection (n=1). Thirteen (21.0%) patients required more than one surgical intervention during the follow up period including complete revision in 2 (3.2%), removal of hardware in six (9.7%), bony recontouring in five (8.1%), and soft tissue augmentation in 1 (1.6%) patient. At follow-up, 63 (55.8%) patients were classified as Whitaker I, 6 (5.3%) were class II, 41 (36.3%) class III, and 3 (2.7%) class IV. Patients noted to have temporal hollowing (p=0.001) or lateral orbital retrusion (p<0.001) were associated with higher Whitaker classification, and this correlated with an increased number of interventions over time (p=0.0012). Patients were stratified based on length of follow up to determine outcome changes over time. Compared to patients with less than 5 years follow up (n=59), patients with greater than 5 years follow-up (n=54) were more likely to have temporal hollowing (OR 3.6, 95%CI 1.7-7.9, p=0.001), lateral orbital retrusion (OR 7.4, 95%CI 3.2-17.2, p<0.0001), and be classified as Whitaker III or IV (OR 6.2, 95%CI 2.6-14.5, p<0.0001).
CONCLUSION:These data represent the largest outcome evaluation of isolated metopic synostosis to date. We characterize the complication and reoperation rates in this population of patients and demonstrate a clear trend toward worsening outcomes over time. These data may change the way we counsel families as well as underscore the need to follow these patients to physical maturity.
Back to Annual Meeting Program